Provider Demographics
NPI:1346570603
Name:VILLEGAS, MARIBEL (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 OLD VILLAGE CENTER CIR
Mailing Address - Street 2:UNIT #9206
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5866
Mailing Address - Country:US
Mailing Address - Phone:954-649-7792
Mailing Address - Fax:
Practice Address - Street 1:319 W TOWN PL
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3101
Practice Address - Country:US
Practice Address - Phone:904-940-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9267529363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001774200Medicaid
FL001774200Medicaid